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General NPI Number Information
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NPI Number | 1588621536
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Entity Type | Organization
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Legal Business Name | TOSA PEDIATRICS SC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 8651 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-2721
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Country | US
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Telephone | 414-774-9200
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Fax | 414-774-9031
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Provider Business Mailing Address
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Address Line | 8651 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-2721
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Country | US
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Telephone | 414-774-9200
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Fax | 414-774-9031
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY MATTHEW RICHER
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Credential | MD
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Telephone | 414-774-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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